Zeynep Tuzcu, DC

Approach to care

• What does it look like for you to provide care to patients in larger bodies? How is, or isn’t, your approach different from how you care for patients in smaller bodies? If you work with children, how is or isn’t your approach different when working with children?

  My priority is meeting patients wherever they find themselves in their wellness journey. I operate from a health-at-every-size and body neutrality approach which centers the patient experience, encourages intuitive eating and prioritizes movement accessibility rather than upholding the outdated standard that weight loss is the way to “become healthy”.

  I treat all of my patients with the best care that I can provide regardless of body size, and I ensure all of my patients feel they are in the drivers seat with me as a gentle and encouraging teammate.

  At this time the majority of my patient base consists of women and non-binary folks ages 25-60, however when I have the privilege of treating a younger patient, it’s even more important to me to avoid positive and negative language and instead use neutral language, in general and specifically around body size.

• What is your perspective on how weight is or is not related to health?

  I think that weight is one of many, many elements that gives us information and context around our health, and it alone absolutely does not determine our health. I do not believe fat in itself is a major player in disease, and this has been cited by multiple scientists, dietitians and nutritionists over recent years.

  Instead, I value my patients social determinants of health like community support or lack thereof, poverty, racism, access to healthy food and mental health services, and any other elements that feel limiting or pain-inducing.

• Finish this sentence: “Fat people are…” 

  Fat people are people deserving of the same level of care, respect and inclusion as their smaller-bodied community members, and their size alone does not directly determine anything around their health.

• How do you, your clinic, and the healthcare system you work in use BMI (i.e BMI cutoffs for accessing certain services, BMI on charts and printouts, etc)? Is this flexible?

  As a chiropractic clinic with the mission of providing inclusive and accessible care, I do not utilize BMI in any capacity at my space. It is an outdated measure created based on data from young, white, able-bodied men, and it has not shown any value to me as a provider.

  I do not take insurance, however patients are welcome to send in their statements and chart info to their insurance. For these cases, I always take three forms of vitals that do not include weight, such as pulse, blood pressure and respirations (at least three vital signs need to be recorded for insurance companies).

• If a patient declines to be weighed, how do you and/or your staff proceed?

  All of my clinic operations are as consent-based as possible. I do not ask nor do I require my patients to be weighed as that is not my priority at the clinic nor is it very relevant to me unless there have been unexpected changes (like autoimmune disease, etc.) for which I generally co-manage with the patient’s primary doctor. If a patient were to decline to be weighed, as I have done personally many times at my primary care clinic, I would gladly perform a different vital like any of the one I listed above.

• If a patient declines to discuss weight loss, nutrition, and/or exercise, how do you proceed?

  It is always a patient’s decision whether they want to discuss these topics, and I always leave it up to them in a judgment-free fashion. Both in my intake forms and my initial and follow-up appointments I ask neutral, open-ended questions around nourishment and movement to ensure my patients are attaining their basic needs. If they choose not to answer, I ask if there is anything I can do to be supportive of them on those journeys. I have rarely had this issue as most of my patients are opening wanting to talk about how to repair their relationship with movement, food and wellness.

• What does the physical accessibility of your office space look like? What kinds of accommodations are present for people in larger bodies? Are there things you wish were in place that are currently not? 

  My clinical space, as any, can always use improvements and I often ask for feedback from colleagues in the body advocacy world. Currently, my clinic is accessible via stairs or elevator, depending on accessibility. In addition, the clinic has wider seating without arm rests in the intake area, one-size-fits-all clinical gowns for all body sizes (used for cupping treatment as needed), a treatment table that goes up and down for ease and comfort of getting on and off for treatment, pelvic blocks to help facilitate pelvic adjustments without patients having to lie on their sides, and I just ordered custom table width extenders to ensure patients feel comfortable on both treatment tables. I also offer many seated adjustments for folks who prefer not to lie down face up or face down. I feel good knowing my patients living in larger bodies have given me such positive feedback with these implementations.

  I use an app called Physitrack to provide my patients with rehabilitation and mobility exercises and movements to help them build an accessible pain management and prevention toolkit at home. Unfortunately, the majority of the exercise videos are demonstrated by homogenous groups (white, smaller-bodied, able-bodied models). I have contacted the support team at Physitrack multiple times expressing my concerns around lack of representation and it is my understanding that they are in the process of diversifying. My wish is that someday I can create and provide my own library of exercise videos that represent many different kinds of bodies.

• What do you do to allow fat people to feel comfortable and welcome in your office? 

  I first and foremost ensure that my patients know I am aware and conscious that they have been living in their bodies much longer than I’ve known them and are therefore invited and welcomed to opt in or out of any of my treatment recommendations. It is extremely important to me that my patients feel comfortable advocating for themselves, which is why consent-based care is a pillar of my practice.

  I am also intentional about creating a warm and open energy every day in the space with curated playlists, calming plant-filled surroundings, neutral scents, and snippets into my own life through my photo wall. I want my patients to enter the clinic and feel the classic Turkish custom of coming home, or to an inviting and safe place that feels like it. This means they can be themselves and leave talk of weight or dieting at the door.

  When building a treatment plan for my patients living in larger bodies, I will modify any of the movements or regimens as needed or desired by my patients to ensure they feel comfortable and accessible.

  I always take time to get to know my patients before and while we dive into their why for visiting my clinic. In order to fully treat them, it is essential for me to understand them as a whole human being. This means taking into account work life, home life, relationships, access to food and water, spirituality, overall sensation of safety, and more. If my patients feel in need of support in an area that is out of scope for me, I make a commitment to getting them in touch with my trusted network of wellness providers to ensure they get on the right path.

• If you’d like to use this space to talk about any identities (gender, race, size, sexuality, etc.) you hold and how this relates to your care, please do so. 

  I am a first generation immigrant and was born in Turkey and adopted from there as a baby by my beautiful and loving Turkish father and American mother. I have been blessed to maintain my cultural connection throughout my life and I am very proud of my heritage. In addition to my hospitality-forward and selfless Turkish values in my DNA, my parents raised me with progressive worldviews which began my lifelong journey of being an activist fiercely standing for the liberation of historically marginalized communities, including the LGBTQ+ community, black, indigenous and people of color, and groups experiencing disadvantages such as folks living in larger bodies. I use she/her pronouns and identify as a cisgender heterosexual woman, and simultaneously know in my cells that gender is a societal construct. I am constantly on my own journey of liberating myself and others from the binaries that exist in our society, and I will always use my voice as a small business owner to speak up for others and for the things I believe in most strongly.